Surgical instrument and method

ABSTRACT

A surgical instrument includes a first member defining an axis and including a cutting surface. A second member includes a cutting surface that is rotatable relative to the first member. A third member includes an outer surface. The cutting surface of the second member is rotatable relative to the outer surface to transfer the cut tissue along the axis. Systems and methods are disclosed.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.16/038,742, which is a division of U.S. patent application Ser. No.14/640,189, filed on Mar. 6, 2015, now U.S. Pat. No. 10,080,571. Theseapplications are hereby incorporated herein by reference, in theirentireties.

TECHNICAL FIELD

The present disclosure generally relates to medical devices for thetreatment of musculoskeletal disorders, and more particularly to asurgical system for preparation of a surgical site and a method fortreating a spine.

BACKGROUND

Spinal disorders such as degenerative disc disease, disc herniation,osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvatureabnormalities, kyphosis, tumor, and fracture may result from factorsincluding trauma, disease and degenerative conditions caused by injuryand aging. Spinal disorders typically result in symptoms including pain,nerve damage, and partial or complete loss of mobility.

Non-surgical treatments, such as medication, rehabilitation and exercisecan be effective, however, may fail to relieve the symptoms associatedwith these disorders. Surgical treatment of these spinal disordersincludes fusion, fixation, corpectomy, discectomy, laminectomy andimplantable prosthetics. In procedures, such as, for example, corpectomyand discectomy, fusion and fixation treatments may be performed thatemploy implants to restore the mechanical support function of vertebrae.Surgical instruments are employed, for example, to prepare tissuesurfaces for disposal of the implants. Surgical instruments are alsoemployed to engage implants for disposal with the tissue surfaces at asurgical site. This disclosure describes an improvement over these priorart technologies.

SUMMARY

In one embodiment, a surgical instrument is provided. The surgicalinstrument includes a first member defining an axis and including acutting surface. A second member includes a cutting surface that isrotatable relative to the first member. A third member includes an outersurface. The cutting surface of the second member is rotatable relativeto the outer surface to transfer the cut tissue along the axis. Systemsand methods of use are disclosed.

BRIEF DESCRIPTION OF THE DRAWINGS

The present disclosure will become more readily apparent from thespecific description accompanied by the following drawings, in which:

FIG. 1 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 2 is a side view of the components shown in FIG. 1 ;

FIG. 3 is a cross section view taken along lines A-A shown in FIG. 2 ;

FIG. 4 is a side view of components of the system shown in FIG. 1 ;

FIG. 5 is an end view of components of the system shown in FIG. 1 ;

FIG. 6 is an end view of components of the system shown in FIG. 1 ;

FIG. 7 is a cross section view taken along lines B-B shown in FIG. 4 ;

FIG. 8 is a cross section view taken along lines C-C shown in FIG. 5 ;

FIG. 9 is a perspective view of components of the system shown in FIG. 1;

FIG. 10 is a side view of components of the system shown in FIG. 1 ;

FIG. 11 is an end view of the components shown in FIG. 10 ;

FIG. 12 is an end view of the components shown in FIG. 10 ;

FIG. 13 is a cross section view of components of the system shown inFIG. 1 ;

FIG. 14 is a cross section view taken along lines G-G shown in FIG. 13 ;

FIG. 15 is a cross section view taken along lines E-E shown in FIG. 10 ;

FIG. 16 is a side view of components of the system shown in FIG. 1 ;

FIG. 17 is an end view of the components shown in FIG. 16 ;

FIG. 18 is a cross section view of components of the system shown inFIG. 1 ;

FIG. 19 is a cross section view taken along lines H-H shown in FIG. 18 ;

FIG. 20 is a perspective view of components of the system shown in FIG.1 ;

FIG. 21 is a side view of the components shown in FIG. 20 ;

FIG. 22 is an end view of the components shown in FIG. 20 ;

FIG. 23 is an end view of the components shown in FIG. 20 ;

FIG. 24 is a cross section view taken along lines I-I shown in FIG. 21 ;

FIG. 25 is a cross section view taken along lines J-J shown in FIG. 21 ;

FIG. 26 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 27 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 28 is a side view of the components shown in FIG. 27 ;

FIG. 29 is an end view of the components shown in FIG. 27 ;

FIG. 30 is an end view of the components shown in FIG. 27 ;

FIG. 31 is a cross section view taken along lines K-K of FIG. 28 ;

FIG. 32 is a cross section view taken along lines L-L of FIG. 28 ;

FIG. 33 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 34 is an end view of the components shown in FIG. 33 ;

FIG. 35 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 36 is an end view of the components shown in FIG. 35 ;

FIG. 37 is a cross section view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 38 is a cross section view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 39 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure with parts separated;

FIG. 40 is a perspective view of components of the system shown in FIG.39 ;

FIG. 41 is a cross section view of components of the system shown inFIG. 39 ; and

FIG. 42 is a cross section view of components of the system shown inFIG. 39 .

DETAILED DESCRIPTION

The exemplary embodiments of the surgical system and related methods ofuse disclosed are discussed in terms of medical devices for thetreatment of musculoskeletal disorders and more particularly, in termsof a surgical system for preparation of a surgical site and a method fortreating a spine.

In one embodiment, the surgical system includes a surgical instrument,such as, for example, a disc preparation instrument. In someembodiments, the surgical instrument includes a manual cutter housingdisposed about an internal rotating cutter. In some embodiments, thesurgical system includes a disc preparation device with a combination ofan outer paddle scraper structure having two or more blades or openingsbetween the blades and an internal rotating auger and/or suctionmechanism for conveying disc debris into the instrument and away fromthe surgical site.

In some embodiments, the surgical system includes a surgical instrumentincluding a rotating cutter housing that provides a rigid protectivecover configured to cover the rotating cutter blade. In someembodiments, the cutter housing includes at least two openings with foursharp edges to facilitate cutting of peripheral material when rotated.In some embodiments, the peripheral material is processed via theinternal cutting and grinding mechanism. In some embodiments, thesurgical instrument includes a housing configured to incorporate one,two, and/or multiple openings to facilitate accessibility to theinternal cutting and grinding mechanism. In some embodiments, thesurgical instrument includes a rotating cutter mechanism disposed withthe rotating cutter housing for cutting and/or macerating disc material.In some embodiments, the surgical instrument includes suction tofacilitate material removal. In one embodiment, the surgical instrumentincludes a navigation device to facilitate positioning and/or trackingof components of the surgical system.

In some embodiments, the surgical instrument is configured to besurgically inserted into a space between vertebral bodies to facilitatecutting and removing tissue and bone to create a space or pathway forfusion or motion implants. In some embodiments, the surgical instrumentincludes a rotating cutter housing, a rotating cutter, a stationaryauger, a rotating grinder, and an irrigation and/or debris removal tube.

In one embodiment, the surgical instrument includes a rotating cutterhaving a circumferential helical cutting geometry that is configured tocreate shear against an inside portion of the housing. In someembodiments, the helical shape can be either a right hand or left handcutter feature. In some embodiments, the surgical instrument includes acannulated rotatable cutter to facilitate mating with a stationaryauger. In some embodiments, the surgical instrument includes arotor/stator combination to facilitate high shear to process cutmaterial into a smaller particle size. In some embodiments, the helicalshape causes cut debris to channel inside the stationary auger and isforced towards a rotating grinder. In some embodiments, the surgicalinstrument includes a rotating cutter having an end configured with acutting geometry to facilitate insertion. In some embodiments, thesurgical instrument includes irrigation surfaces that facilitateirrigation to enter the auger channels to mix with debris to provide atransfer mixture, and create a hydraulic bearing surface between movingparts of the cutter.

In one embodiment, the surgical instrument includes a stationary augermember that includes a rotational pitch opposite of the cutter to createa force along auger channels to transfer cut material towards a rotatinggrinder. In some embodiments, the auger is cannulated to facilitateirrigation to transfer to a tip of the rotating cutter. In someembodiments, the surgical instrument includes a rotating cutter havingirrigation and/or a hydraulic bearing surface and irrigation holes.

In one embodiment, the surgical instrument includes a rotating grinderthat includes pathways to facilitate irrigation around a peripheralsurface of the rotating cutter to transfer to the cannulated stationaryauger member. In one embodiment, the rotating grinder includes agrinding surface and a debris portal. In one embodiment, the rotatinggrinder includes an irrigation channel and debris removal oriented in aselected direction. In some embodiments, the surgical instrumentincludes a grinding surface configured to cause a high shear with thestationary auger member as material is forced into debris portals.

In one embodiment, the surgical instrument includes debris irrigationand suction. In one embodiment, the surgical instrument includes amanual blade with a spinning cutter having an internal stationary auger.In some embodiments, the surgical instrument includes an irrigation portdisposed in a handle and a suction connection in the handle. In oneembodiment, the manual blade includes a pair of cutting elements. In oneembodiment, the manual blade includes four cutting elements oriented ina cruciate configuration. In one embodiment, the surgical instrumentincludes scrape blades and rotating blades. In one embodiment, thesurgical instrument is employed with a method such that a surgeon cutsaway disc and endplate tissue with the manual blade by manually rotatingand/or scraping the tissue. In some embodiments, the method includes thestep of moving tissue debris into ports between the manual blades.

In some embodiments, the surgical instrument includes an auger having acentral cannula configured for disposal of a piston. In someembodiments, the piston is disposed with the central cannula and withina rotating blade disposed thereabout. In some embodiments, the pistontranslates relative to the auger in a first axial direction and/or in asecond axial direction to move tissue debris. In some embodiments, thepiston comprises a compactor to engage and move tissue debris forremoval of the tissue debris from the auger and/or to facilitategrinding and cutting of tissue.

In some embodiments, components of the surgical instrument have acentral cannula configured for disposal of an illumination device. Insome embodiments, the illumination device includes a fiber-optic lightcable. In some embodiments, components of the surgical instrumentinclude a fiber-optic light and a camera mounted with an outer housingand/or a stationary shaft, as described herein. In some embodiments, thecamera includes a miniature camera.

In some embodiments, the surgical instrument includes an augercomprising two or more counter rotating internal blades. In someembodiments, the blades are co-axially disposed and comprise alternatediameters, increasing or decreasing. In some embodiments, the blades areseparate and disposed in a serial configuration. In some embodiments,the blades may rotate in the same or different directions.

In some embodiments, the surgical instrument includes a manual cutterhousing that collects tissue debris, as described herein, and arrestsmovement of the components of the surgical system to close and seal thesurgical instrument. In some embodiments, this configuration increases asuction force to facilitate removal of tissue debris from the cuttersand/or blades. In some embodiments, the components of the surgicalinstrument can be heated and/or cooled to facilitate processing oftissue, as described herein. In some embodiments the surgical instrumentincludes an inner blade, such as, for example, the stationary shaft,having a heating or cooling element that heats or freezes tissue, suchas, for example, intervertebral disc tissue and an outer blade, such as,for example, the rotatable cutter, having an insulating element disposedabout the inner blade. The heating or cooling element can beelectrically connected to a power source.

In some embodiments, the cutting surfaces or blades of the components ofthe surgical instrument, as described herein, can include, such as, forexample, diamonds, spikes and/or sandpaper. In some embodiments, thesurgical system includes a diverting filter connected to the surgicalinstrument and configured to bifurcate tissue debris into a plurality ofportions of the filter. In some embodiments, the filter includes atleast one portion that facilitates trapping and collecting bone.

In some embodiments, the surgical system includes a device configured toinject a bio-material, such as, for example, a polymer, cement, orstiffener into intervertebral disc tissue. In some embodiments, thebio-material is injected with tissue to quick set at the time of surgeryor prepared and introduced before the surgery. In some embodiments, thesurgical system includes a bio-material, such as, for example, adiscogram injection to stiffen intervertebral disc tissue and increasecutting efficiency. In some embodiments, the surgical system is employedwith a method such that intervertebral disc tissue is heated and/orbio-frozen prior to cutting to alter the disc material characteristicsand to facilitate cutting.

In one embodiment, one or all of the components of the surgical systemare disposable, peel-pack, pre-packed sterile devices that can be usedwith an implant. One or all of the components of the surgical system maybe reusable. The surgical system may be configured as a kit withmultiple sized and configured components.

In some embodiments, the present disclosure may be employed to treatspinal disorders such as, for example, degenerative disc disease, discherniation, osteoporosis, spondylolisthesis, stenosis, scoliosis andother curvature abnormalities, kyphosis, tumor and fractures. In someembodiments, the present disclosure may be employed with other ostealand bone related applications, including those associated withdiagnostics and therapeutics. In some embodiments, the disclosedsurgical system and methods may be alternatively employed in a surgicaltreatment with a patient in a prone or supine position, and/or employvarious surgical approaches to the spine, including anterior, posterior,posterior mid-line, direct lateral, postero-lateral, and/orantero-lateral approaches, and in other body regions. The presentdisclosure may also be alternatively employed with procedures fortreating the lumbar, cervical, thoracic and pelvic regions of a spinalcolumn. The system and methods of the present disclosure may also beused on animals, bone models and other non-living substrates, such as,for example, in training, testing and demonstration.

The present disclosure may be understood more readily by reference tothe following detailed description of the disclosure taken in connectionwith the accompanying drawing figures, which form a part of thisdisclosure. It is to be understood that this disclosure is not limitedto the specific devices, methods, conditions or parameters describedand/or shown herein, and that the terminology used herein is for thepurpose of describing particular embodiments by way of example only andis not intended to be limiting of the claimed disclosure. Also, in someembodiments, as used in the specification and including the appendedclaims, the singular forms “a,” “an,” and “the” include the plural, andreference to a particular numerical value includes at least thatparticular value, unless the context dearly dictates otherwise. Rangesmay be expressed herein as from “about” or “approximately” oneparticular value and/or to “about” or “approximately” another particularvalue. When such a range is expressed, another embodiment includes fromthe one particular value and/or to the other particular value.Similarly, when values are expressed as approximations, by use of theantecedent “about,” it will be understood that the particular valueforms another embodiment. It is also understood that all spatialreferences, such as, for example, horizontal, vertical, top, upper,lower, bottom, left and right, are for illustrative purposes only andcan be varied within the scope of the disclosure. For example, thereferences “upper” and “lower” are relative and used only in the contextto the other, and are not necessarily “superior” and “inferior”.

As used in the specification and including the appended claims,“treating” or “treatment” of a disease or condition refers to performinga procedure that may include administering one or more drugs to apatient (human, normal or otherwise or other mammal), in an effort toalleviate signs or symptoms of the disease or condition. Alleviation canoccur prior to signs or symptoms of the disease or condition appearing,as well as after their appearance. Thus, treating or treatment includespreventing or prevention of disease or undesirable condition (e.g.,preventing the disease from occurring in a patient, who may bepredisposed to the disease but has not yet been diagnosed as having it).In addition, treating or treatment does not require complete alleviationof signs or symptoms, does not require a cure, and specifically includesprocedures that have only a marginal effect on the patient. Treatmentcan include inhibiting the disease, e.g., arresting its development, orrelieving the disease, e.g., causing regression of the disease. Forexample, treatment can include reducing acute or chronic inflammation;alleviating pain and mitigating and inducing re-growth of new ligament,bone and other tissues; as an adjunct in surgery; and/or any repairprocedure. Also, as used in the specification and including the appendedclaims, the term “tissue” includes soft tissue, ligaments, tendons,cartilage and/or bone unless specifically referred to otherwise.

The following discussion includes a description of a surgical system andrelated methods of employing the surgical system in accordance with theprinciples of the present disclosure. Alternate embodiments are alsodisclosed. Reference is made in detail to the exemplary embodiments ofthe present disclosure, which are illustrated in the accompanyingfigures. Turning to FIGS. 1-25 , there are illustrated components of asurgical system 10 including a surgical instrument 12.

The components of surgical system 10 can be fabricated from biologicallyacceptable materials suitable for medical applications, includingmetals, synthetic polymers, ceramics and/or their composites. Forexample, the components of surgical system 10, individually orcollectively, can be fabricated from materials such as stainless steelalloys, commercially pure titanium, titanium alloys, Grade 5 titanium,super-elastic titanium alloys, cobalt-chrome alloys, stainless steelalloys, superelastic metallic alloys (e.g., Nitinol, superelasto-plastic metals, such as GUM METAL® manufactured by ToyotaMaterial Incorporated of Japan), ceramics and composites thereof such ascalcium phosphate (e.g., SKELITE™ manufactured by Biologix Inc.),thermoplastics such as polyaryletherketone (PAEK) includingpolyetheretherketone (PEEK), polyetherketoneketone (PEKK) andpolyetherketone (PEK), carbon-PEEK composites, PEEK-BaSO₄ polymericrubbers, polyethylene terephthalate (PET), fabric, silicone,polyurethane, silicone-polyurethane copolymers, polymeric rubbers,polyolefin rubbers, hydrogels, semi-rigid and rigid materials,elastomers, rubbers, thermoplastic elastomers, thermoset elastomers,elastomeric composites, rigid polymers including polyphenylene,polyamide, polyimide, polyetherimide, polyethylene, epoxy, partiallyresorbable materials, such as, for example, composites of metals andcalcium-based ceramics, composites of PEEK and calcium based ceramics,composites of PEEK with resorbable polymers, totally resorbablematerials, such as, for example, calcium based ceramics such as calciumphosphate, tri-calcium phosphate (TCP), calcium sulfate, or otherresorbable polymers such as polyaetide, polyglycolide, polytyrosinecarbonate, polycaroplaetohe and their combinations.

Various components of surgical system 10 may have material composites,including the above materials, to achieve various desiredcharacteristics such as strength, rigidity, elasticity, compliance,biomechanical performance, durability and radiolucency or imagingpreference. The components of surgical system 10, individually orcollectively, may also be fabricated from a heterogeneous material suchas a combination of two or more of the above-described materials. Thecomponents of surgical system 10 may be monolithically formed,integrally connected or include fastening elements and/or instruments,as described herein.

The components of surgical system 10 including surgical instrument 12can be employed, for example, with mini-open and open surgicaltechniques to prepare a surgical site including tissue in connectionwith a surgical procedure for delivery and introduction ofinstrumentation and/or an implant, such as, for example, anintervertebral implant, at a surgical site within a body of a patient,for example, a section of a spine. In one embodiment, surgical system 10may be employed with surgical procedures, such as, for example,corpectomy and discectomy, which include fusion and/or fixationtreatments that employ implants.

Surgical instrument 12 includes a member, such as, for example, a body14 that extends between an end 16 and an end 18. Body defines an axis X1and includes a housing 20. In some embodiments, housing 20 may havecross section configurations, such as, for example, oval, cylindrical,triangular, square, polygonal, irregular, uniform, non-uniform, offset,staggered, undulating, arcuate, variable and/or tapered. Housing 20includes an inner surface 21 that defines a cavity, such as, forexample, a channel 22. Channel 22 is configured for disposal of amember, such as, for example, an auger 24, as described herein. In someembodiments, channel 22 may have various cross section configurations,such as, for example, circular, cylindrical, oval, oblong, triangular,rectangular, square, polygonal, irregular, uniform, non-uniform,variable, tubular and/or tapered. In some embodiments, housing 20 isconfigured to provide a rigid protective cover for auger 24.

Housing 20 includes a wall 26 disposed about auger 24. Wall 26 includesa thickness and a surface 30. Surface 30 defines spaced openings 32extending through the thickness of wall 26. Wall 26 includes a cuttingsurface 34 that is disposed about openings 32. Wall 26 has a taperedcross section configuration that extends to cutting surface 34, whichincludes blades 36. Blades 36 are configured to disrupt, scrape, cutand/or remove tissue from a surgical site. In some embodiments, housing20 may include one or a plurality of spaced openings.

Manipulation including rotation, translation and/or angulation ofhousing 20 causes blades 36 to disrupt, scrape, cut and/or remove tissueat a surgical site and guide tissue into channel 22. In someembodiments, blades 36 are configured for disposal between vertebralbodies to disrupt, scrape, cut and/or remove tissue, such as, forexample, intervertebral disc tissue and/or vertebral endplate tissue tocreate a cavity, space and/or pathway at a surgical site including atargeted portion of an anatomy for delivery, introduction and/orimplantation of a spinal implant. In some embodiments, cutting surface34 is disposed at an angle α relative to an axis X2 of housing 20 todirect cut tissue into channel 22. In some embodiments, angle α is 45degrees. In some embodiments, angle α may include an angle in a range of0 through 180 degrees. In some embodiments, cutting surface 34 may bedisposed at alternate orientations relative to housing 20, such as, forexample, transverse, perpendicular and/or other angular orientationssuch as acute or obtuse, co-axial and/or may be offset or staggered.

Auger 24 is configured for disposal in channel 22. Auger 24 includes amember, such as, for example, a rotatable cutter 50 and a member, suchas, for example, a stationary shaft 52. Cutter 50 extends between an end54 and an end 56. Cutter 50 extends along axis X1 when disposed inchannel 22. Cutter 50 is tubular in configuration. In some embodiments,cutter 50 may have cross section configurations, such as, for example,oval, cylindrical, triangular, square, polygonal, irregular, uniform,non-uniform, offset, staggered, undulating, arcuate, variable and/ortapered.

Cutter 50 includes a surface 58 that defines a plurality of spacedcutting flutes 60. Cutting flutes 60 are spaced along cutter 50 and formhelical blades 62 extending along a length of cutter 50. Helical blades62 are disposed at a rotational pitch R1. In some embodiments, surface58 includes a scaffold and/or network of blades. In some embodiments,blades 62 may be disposed at alternate relative orientations, such as,for example, parallel, transverse and/or other angular orientations suchas acute or obtuse, co-axial and/or may be offset or staggered. Blades62 are configured for rotation within housing 20 and about shaft 52 todisrupt, scrape, cut, shear and/or macerate tissue and/or transferand/or convey tissue along shaft 52, as described herein.

Cutter 50 includes an inner surface 64 that defines an interior cavity66. Cavity 66 is configured for disposal of shaft 52 within housing 20,as described herein. Cutter 50 is configured for rotation relative toshaft 52 to transfer tissue along a first direction, such as, forexample, a direction D1 along axis X1, as shown in FIG. 3 and describedherein. In some embodiments, blades 62 rotate relative to shaft 52within housing 20 to disrupt, scrape, cut, shear and/or macerate cuttissue from blades 36 into a smaller particle size for removal asurgical site. In some embodiments, blades 62 rotate such that tissuedisposed adjacent and/or between cutter 50 and shaft 52 is transferredand/or conveyed in direction D1 due to fluid transfer forces createdbetween the helical configurations of cutter 50 and shaft 52. The tissueis transferred and/or conveyed towards a member, such as, for example, agrinder 100 for removal from a surgical site, as described herein. Insome embodiments, auger 24 comprises two or more counter rotatinginternal blades, similar to cutter 50. In some embodiments, the bladesare co-axially disposed and comprise alternate diameters, increasing ordecreasing. In some embodiments, the blades are separate and disposed ina serial configuration. In some embodiments, the blades may rotate inthe same or different directions.

End 54 includes a portion 67 having a surface 68 and a surface 69.Surface 68 defines an opening 70 configured for disposal of a portion ofgrinder 100. Surface 69 includes a cavity, such as, for example, agroove 71. Groove 71 is in communication with a fluid F supplied from anirrigation port, as described herein. Fluid F flows along groove 71through openings, such as, for example, irrigation holes 72. Holes 72are configured to direct fluid F through grinder 100 and into shaft 52,as described herein. In some embodiments, fluid F passes along groove 70and provides a hydraulic bearing surface with grinder 100 to facilitaterotation of cutter 50 and prevent wear, overheating and/or damage duringoperation of the components of surgical instrument 12.

Shaft 52 extends between an end 80 and an end 82 along axis X1 whendisposed in housing 20. Shaft 52 is configured for disposal with cavity66. Shaft 52 is fixed with housing 20 by a protrusion, such as, forexample, a flange 74. Flange 74 is fixedly attached with shaft 52 toresist and/or prevent rotation. In some embodiments, shaft 52 may havecross section configurations, such as, for example, oval, cylindrical,triangular, square, polygonal, irregular, uniform, non-uniform, offset,staggered, undulating, arcuate, variable and/or tapered.

Shaft 52 includes a surface 84 that defines a helical surface 86.Helical surface 86 is disposed in an alternate orientation relative tohelical blades 62. Helical surface 86 includes a rotational pitch R2that is alternative to rotational pitch R1 to create a dynamic fluidtransfer and/or shear force or pressure to transfer and/or convey tissuefrom a surgical site in direction D1. Helical blades 62 and helicalsurface 86 form a transfer channel 88 therebetween configured to directcut tissue along axis X1 towards grinder 100 in direction D1. Thedynamic fluid transfer and/or shear force created by rotation of cutter50 relative to shaft 52 and between helical blades 62 and helicalsurface 86 direct fluid flow and cut tissue within transfer channel 88.In some embodiments, surface 58 and/or surface 84 may comprise alternateconfigurations, such as, for example, grooved, channeled, undulating,even, uniform, non-uniform, offset, staggered, textured and/or taperedto facilitate directional flow of fluid F. In one embodiment, as shownin FIG. 37 , shaft 52 includes fiber-optic light cable 89 disposedand/or helically wound through a surface of shaft 52. Light-cable 89illuminates a surgical site. In some embodiments, an illumination devicemay be mounted with various components of surgical instrument 12. In oneembodiment, a miniature camera (not shown) can be mounted with variouscomponents of surgical instrument 12 to facilitate imaging of thesurgical site.

Shaft 52 is cannulated to define a passageway 90 configured for transferof fluid F in a direction, such as, for example, a direction D2.Passageway 90 is in communication with irrigation holes 72 via channels118, 120, 122, as described herein. Surface 84 at end 82 defines atleast one opening 92 configured to direct fluid flow F out of passageway90 into transfer channel 88. The force of fluid flow F travellingthrough passageway 90 causes fluid flow F to exit passageway 90 throughopenings 92. Fluid F is expelled from passageway 90 and is utilized tofacilitate transfer of tissue along transfer channel 88 in direction D1to grinder 100. Movement of fluid F through openings 92 creates ahydraulic bearing surface at ends 82, 56 between cutter 50 and shaft 52to facilitate rotation of cutter 50 and prevent wear, overheating and/ordamage during operation of the components of surgical instrument 12.

Grinder 100 extends between an end 102 and an end 104. End 104 isconfigured for disposal in portion 67 of cutter 50. Grinder 100 includesa surface 106 that defines a cutting surface, such as, for example, aplurality of arcuate cutting blades 108 configured to cut, shear and/ormacerate cut tissue from transfer channel 88 into a smaller particlesize for removal from a surgical site. Cutting blades 108 form openings110. Grinder 100 includes a surface 112 that defines a debris reservoir114. Openings 110 are in communication with debris reservoir 114 suchthat the tissue that passes through openings 110 is transferred and/orconveyed into debris reservoir 114 for removal by a vacuum sourceattached with housing 20. In some embodiments, the cutting surfacesdescribed herein may include blades, serrations, tines, sharpenedsurfaces and/or edges.

Grinder 100 includes a surface 116 that defines a fluid flow pathway,such as, for example, a series of channels, such as, for example,channels 118, 120, 122. Channels 118, 120, 122 communicate at junction124 to facilitate the flow of fluid F through grinder 100 intopassageway 90. In some embodiments, channels 118, 120, 122 may bedisposed at alternate relative orientations, such as, for example,transverse, perpendicular and/or other angular orientations such asacute or obtuse, co-axial and/or may be offset or staggered.

Channels 118, 120, 122 are each configured for alignment with holes 72during rotation to receive fluid F. Junction 124 is oriented incommunication with passageway 90. Channels 118, 120, 122 are configuredto receive fluid flow F from holes 72 and direct fluid flow F tojunction 124 into passageway 90 of shaft 52, as described herein, todirect fluid F in direction D2 into passageway 90.

Grinder 100 is configured for rotation relative to shaft 52 between anopen, fluid communication position such that openings 110 are alignedwith transfer channel 88 to facilitate passage of cut tissue fromtransfer channel 88 to debris reservoir 114 and a closed,non-communicating position such that surface 106 prevents passage of cuttissue from transfer channel 88 into debris reservoir 114. As grinder100 rotates between the open and closed positions of openings 110,blades 108 shear tissue with shaft 52 to cut, shear and/or macerate cuttissue from transfer channel 88 into a smaller particle size for removalfrom a surgical site. Cut tissue is transferred and/or conveyed withfluid F in direction D1. In some embodiments, the open position ofgrinder 100 comprises a range of alignment of openings 110 with transferchannel 88 including a fully open position of openings 110 throughgradual closing of openings 110 during rotation to a completely closedorientation such that surface 106 completely blocks openings 110.

An irrigation port is configured to deliver fluid F into surgicalinstrument 12, through holes 72, through channels 118, 120, 122 and intopassageway 90. The force of fluid flow F directs cut tissue throughtransfer channel 88 to grinder 100. Fluid F mixed with tissue istransferred into debris reservoir 114 for removal via the vacuum sourceconnected with surgical instrument 12. In some embodiments, surgicalsystem 10 includes a diverting filter (not shown) connected to surgicalinstrument 12 and configured to bifurcate tissue debris into a pluralityof portions of the filter. In some embodiments, the filter includes atleast one portion that facilitates trapping and collecting bone.

In assembly, operation and use, as shown in FIG. 26 , surgical system 10is employed to treat an affected section of vertebrae V. A medicalpractitioner obtains access to a surgical site including vertebrae V inany appropriate manner, such as through incision and retraction oftissues. The components of surgical system 10 including surgicalinstrument 12 are employed to augment a surgical treatment. Surgicalinstrument 12 can be delivered to a surgical site as a pre-assembleddevice or can be assembled in situ. Surgical system 10 may be may becompletely or partially revised, removed or replaced.

Surgical system 10 may be used with surgical methods or techniquesincluding open surgery, mini-open surgery, minimally invasive surgeryand percutaneous surgical implantation, whereby vertebrae V is accessedthrough a mini-incision, or sleeve that provides a protected passagewayto the area. Once access to the surgical site is obtained, a surgicaltreatment, for example, corpectomy and/or discectomy, can be performedfor treating a spine disorder. A diseased and/or damaged portion ofvertebrae V between and/or including vertebra V1, V2, and diseasedand/or damaged intervertebral discs and tissue are removed to create avertebral space S.

Surgical instrument 12 is delivered to the surgical site includingvertebrae V and inserted with space S. Housing 20 is manipulatedincluding rotation, translation and/or angulation of housing 20 forengagement with vertebral tissue, including but not limited tointervertebral tissue, endplate tissue and bone, adjacent space Scausing blades 36 to disrupt, scrape, cut and/or remove tissue from thesurgical site and guide tissue into channel 22, as described herein. Anactuator, such as, for example, an electric motor is connected withsurgical instrument 12 to actuate rotation of cutter 50 and grinder 100relative to shaft 52.

A source of fluid F is connected to the irrigation port of surgicalinstrument 12 to establish fluid flow in directions D1, D2, as describedherein. Cutter 50 rotates relative to shaft 52 such that blades 62rotate to disrupt, scrape, cut, shear and/or macerate cut tissue fromblades 36 into a smaller particle size for removal the surgical site.

Blades 62 rotate such that tissue disposed adjacent and/or betweencutter 50 and shaft 52 is transferred and/or conveyed in direction D1due to fluid transfer forces created between the helical configurationsof cutter 50 and shaft 52. The dynamic fluid transfer and/or shear forcecreated by rotation of cutter 50 relative to shaft 52 and betweenhelical blades 62 and helical surface 86 direct fluid F and cut tissuewithin transfer channel 88, as described herein.

The tissue is transferred and/or conveyed to grinder 100 for removalfrom the surgical site. As grinder 100 rotates between the open andclosed positions of openings 110, as described herein, blades 108 sheartissue with shaft 52 to cut, shear and/or macerate cut tissue fromtransfer channel 88 into a smaller particle size for removal from thesurgical site. Cut tissue is transferred and/or conveyed with fluid F indirection D1. The force of fluid F directs cut tissue through transferchannel 88 to grinder 100. Fluid F mixed with tissue is transferred intodebris reservoir 114 for removal via the vacuum source connected withsurgical instrument 12.

In some embodiments, surgical system 10 can include one or more surgicalinstruments for use with surgical instrument 12, such as, for example,drivers, inserters, extenders, reducers, spreaders, distractors, blades,retractors, clamps, forceps, elevators and drills, which may bealternately sized and dimensioned, and arranged as a kit.

In one embodiment, surgical system 10 includes an agent, which may bedisposed, packed, coated or layered within, on or about the componentsand/or surfaces of surgical system 10. In some embodiments, the agentmay include bone growth promoting material, such as, for example, bonegraft to enhance fixation of the components and/or surfaces of surgicalsystem 10 with vertebrae V. In some embodiments, the agent may includeone or a plurality of therapeutic agents and/or pharmacological agentsfor release, including sustained release, to treat, for example, pain,inflammation and degeneration.

Upon completion of the procedure, the surgical instruments, assembliesand non-implanted components of surgical system 10 are removed and theincision is closed. The components of surgical system 10 can be made ofradiolucent materials such as polymers. Radiomarkers may be included foridentification under x-ray, fluoroscopy, CT or other imaging techniques.In some embodiments, the use of surgical navigation, microsurgical andimage guided technologies may be employed to access, view and repairspinal deterioration or damage, with the aid of surgical system 10. Insome embodiments, surgical system 10 may include one or a plurality ofplates, connectors and/or bone fasteners for use with a single vertebrallevel or a plurality of vertebral levels.

In one embodiment, as shown in FIGS. 27-32 , system 10, similar to thesystems and methods described herein, includes surgical instrument 12having a grinder 200, similar to grinder 100 described herein. Grinder200 extends between an end 202 and an end 204. End 204 is configured fordisposal in portion 67 of cutter 50 (FIG. 9 ). Grinder 200 includes asurface 206 that defines arcuate cutting blades 208, similar to blades108 described herein, configured to cut, shear and/or macerate cuttissue from transfer channel 88 (FIG. 3 ) into a smaller particle sizefor removal from a surgical site. Cutting blades 208 form opening 210,similar to openings 110 described herein. Grinder 200 includes a debrisreservoir 214. Opening 210 is in communication with debris reservoir 214such that the tissue that passes through opening 210 is transferredand/or conveyed into debris reservoir 214 for removal by a vacuum sourceattached with housing 20 (FIG. 1 ).

Grinder 200 includes a channel 218, similar to channels 118, 120, 122described herein, which facilitates the flow of fluid F through grinder200 into passageway 90. Channel 218 is configured for alignment withholes 72 during rotation of cutter 50 to receive fluid F. Channel 218 isconfigured to receive fluid F from holes 72 and direct fluid F intopassageway 90 of shaft 52, as described herein, to direct fluid F indirection D2 into passageway 90.

Grinder 200 is configured for rotation relative to shaft 52 between anopen, fluid communication position such that opening 210 is aligned withtransfer channel 88 to facilitate passage of cut tissue from transferchannel 88 to debris reservoir 214 and a partially closed position suchthat surface 206 at least partially prevents passage of cut tissue fromtransfer channel 88 into debris reservoir 214. As grinder 200 rotatesbetween the open and closed positions of opening 210, blades 208 cut,shear and/or macerate cut tissue from transfer channel 88 into a smallerparticle size for removal from a surgical site. Cut tissue istransferred and/or conveyed with fluid F in direction D1.

The irrigation port is configured to deliver fluid F into surgicalinstrument 12, through holes 72, through channel 218 and into passageway90. The force of fluid F directs cut tissue through transfer channel 88to grinder 200. Fluid F mixed with tissue is transferred into debrisreservoir 214 for removal via the vacuum source connected with surgicalinstrument 12.

In one embodiment, as shown in FIGS. 33 and 34 , system 10, similar tothe systems and methods described herein, includes surgical instrument12 having a housing 320, similar to housing 20 described herein. Housing320 includes an inner surface 321 that defines a channel 322 configuredfor disposal of auger 24, as described herein.

Housing 320 includes a wall 326 disposed about auger 24. Wall 326includes a thickness and a surface 330. Surface 330 defines four spacedopenings 332 extending through the thickness of wall 326. Wall 326includes four spaced sections that comprise a cruciate cross sectionconfiguration. The sections are spaced 90 degrees apart and extendlinearly to cutting surfaces 334, similar to surfaces 34 describedherein, and are disposed about openings 332. Cutting surfaces 334include blades 336, similar to blades 36 described herein. Blades 336are configured to disrupt, scrape, cut and/or remove tissue from asurgical site. Manipulation including rotation, translation and/orangulation of housing 320 causes blades 336 to disrupt, scrape, cutand/or remove tissue at a surgical site and guide tissue into channel322, in the direction shown by arrows A in FIG. 34 .

In one embodiment, as shown in FIGS. 35 and 36 , system 10, similar tothe systems and methods described herein, includes surgical instrument12 having a housing 420, similar to housing 20 described herein. Housing420 includes an inner surface 421 that defines a channel 422 configuredfor disposal of auger 24, as described herein.

Housing 420 includes a wall 426 disposed about auger 24. Wall 426includes a thickness and a surface 430. Surface 430 defines two spacedopenings 432 extending through the thickness of wall 426. Wall 426includes two spaced sections that are disposed in alignment and/orco-axial along an axis transverse to axis X1. The sections are spaced180 degrees apart and extend linearly to cutting surfaces 434, similarto surfaces 34 described herein, and are disposed about openings 432.Cutting surfaces 434 include blades 436, similar to blades 36 describedherein. Blades 436 are configured to disrupt, scrape, cut and/or removetissue from a surgical site. Manipulation including rotation,translation and/or angulation of housing 420 causes blades 436 todisrupt, scrape, cut and/or remove tissue at a surgical site and guidetissue into channel 422, in the direction shown by arrows B in FIG. 36 .

In one embodiment, as shown in FIG. 38 , system 10, similar to thesystems and methods described herein, includes surgical instrument 12having a stationary shaft 552, similar to stationary shaft 52 describedherein. Shaft 552 is disposed within cavity 66 and has a reduced lengthsuch that cutter 50 and shaft 552 define a cavity portion 554 of cavity66.

A piston 556 is configured for disposal with cavity portion 554. Piston556 is configured for translation within cavity portion 554 along axisX1, in the directions shown by arrows E, to compact cut tissue, asdescribed herein. In some embodiments, piston 556 includes a surface 558that defines openings 560. Openings 560 are configured to provide apassageway for fluid flow F into a passageway 590, similar to passageway90 described herein, and facilitate axial translation of piston 556relative to cutter 50. As fluid flow F passes through passageway 590 andopenings 560, piston 556 translates, in the directions shown by arrowsE. Piston 556 translates relative to cutter 50 to move tissue debris, asdescribed herein. In some embodiments, piston 556 comprises a compactorto engage and move tissue debris for removal of the tissue debris fromauger 24. The dynamic fluid transfer and/or shear force created byrotation of cutter 50, similar to that described herein, directs fluidflow F and cut tissue into cavity 554 such that piston 556 compacts thecut tissue and directs the cut tissue into a grinder, similar to thegrinders described herein, to facilitate grinding and cutting of tissue.

In one embodiment, as shown in FIGS. 39-42 , system 10, similar to thesystems and methods described herein, includes a surgical instrument612, similar to surgical instrument 12 described herein. Surgicalinstrument 612 includes a member, such as, for example, a body 614,similar to body 14 described herein, which defines an axis X2 andincludes a housing 620, similar to housing 20 described herein. Housing620 includes an inner surface 621 that defines a channel 622. Channel622 is configured for disposal of a member, such as, for example, anauger 624, as described herein.

Housing 620 includes a wall 626 disposed about auger 624. Wall 626defines spaced openings 632 and includes blades 636, similar to blades36 described herein. Manipulation including rotation, translation and/orangulation of housing 620 causes blades 636 to disrupt, scrape, cutand/or remove tissue at a surgical site and guide tissue into channel622.

Auger 624, similar to auger 24 described herein, is configured fordisposal in channel 622. Auger 624 includes a member, such as, forexample, a rotatable cutter 650 and a member, such as, for example, astationary shaft 652. Shaft 652 extends between an end 680 and an end682 along axis X2 when disposed in housing 620. Shaft 652 is tubular andconfigured for disposal with channel 622. Shaft 652 is fixedly attachedwith housing 620 adjacent end 680 and/or end 682 to resist and/orprevent relative rotation therebetween. In some embodiments, shaft 652may have cross section configurations, such as, for example, oval,cylindrical, triangular, square, polygonal, irregular, uniform,non-uniform, offset, staggered, undulating, arcuate, variable and/ortapered. Shaft 652 includes a wall surface that defines a channel 684and a plurality of openings 686 that are circumferentially disposedabout the wall surface. Openings 686 receive cut tissue, as describedherein, adjacent openings 632 and facilitate, direct, transfer and/orconvey the cut tissue to cutter 650.

Cutter 650 extends between an end 654 and an end 656. Cutter 650 extendsalong axis X2 when disposed in channel 684. Cutter 650 is tubular andconfigured for disposal within channel 684. In some embodiments, cutter650 is connected with housing 620 via a flange 674 that facilitiesrotation of cutter 650 relative to housing 620. In some embodiments,cutter 650 may have cross section configurations, such as, for example,oval, cylindrical, triangular, square, polygonal, irregular, uniform,non-uniform, offset, staggered, undulating, arcuate, variable and/ortapered.

Cutter 650 includes a surface 658 that defines a plurality of spacedcutting flutes 660. Cutting flutes 660 are spaced along cutter 650 andform helical blades 662, similar to blades 62 described herein,extending along a length of cutter 650. Blades 662 are configured forrotation within housing 620 and within shaft 652 to disrupt, scrape,cut, shear and/or macerate tissue and/or transfer and/or convey tissuealong shaft 652, as described herein.

Cutter 650 includes an inner surface 664 that defines an interior cavity665. Cutter 650 is configured for rotation relative to shaft 652 totransfer tissue in a direction D3 along axis X2, as shown in FIG. 41 .In some embodiments, blades 662 rotate relative to shaft 652 withinhousing 620 to disrupt, scrape, cut, shear and/or macerate cut tissuefrom blades 636 into a smaller particle size for removal a surgicalsite. In some embodiments, blades 662 rotate such that tissue disposedadjacent and/or between cutter 650 and shaft 652, and/or within cavity665, is transferred and/or conveyed in direction D3 due to fluidtransfer forces created between the helical configuration and rotationof cutter 650 relative to shaft 652 and/or housing 620. The tissue istransferred and/or conveyed towards a member, such as, for example, acannula 700 for removal from a surgical site, similar to the systems andmethods described herein.

Cannula 700 defines a transfer channel 702 that receives cut tissue fromcavity 665 and directs the cut tissue in direction D3 along axis X2 forremoval from a surgical site. In some embodiments, a vacuum source isconnected to cannula 700 to direct fluid flow and cut tissue intotransfer channel 702 and for removal from a surgical site. In someembodiments, a dynamic fluid transfer and/or shear force created byrotation of cutter 650 relative to shaft 652 directs fluid flow and cuttissue into transfer channel 702. End 654 includes a wall surface 668that defines an opening 670 configured for disposal of a portion ofcannula 700.

In some embodiments, fluid F flows through irrigation holes 672, whichare in communication with fluid F supplied from an irrigation port, asdescribed herein, for transfer of fluid F in a direction D4, as shown inFIG. 41 . In some embodiments, holes 672 are configured to direct fluidF into channel 622, channel 684 and/or cavity 665, similar to thatdescribed herein. In some embodiments, surface 668 includes one or moregrooves 671, which are in communication with a fluid F supplied from anirrigation port. In some embodiments, fluid F provides a hydraulicbearing surface between shaft 652, cutter 650 and/or housing 620 tofacilitate rotation of cutter 650 and prevent wear, overheating and/ordamage during operation of the components of surgical instrument 612.

An irrigation port is connected with components of surgical instrument612 to deliver fluid F into surgical instrument 612, through holes 672and into cavity 665, as described herein. In some embodiments, rotationof cutter 650 and the force of fluid flow F directs cut tissue throughcavity 665 to transfer channel 702. Fluid F mixed with tissue istransferred into transfer channel 702 for removal via the vacuum sourceconnected with surgical instrument 612.

It will be understood that various modifications may be made to theembodiments disclosed herein. Therefore, the above description shouldnot be construed as limiting, but merely as exemplification of thevarious embodiments. Those skilled in the art will envision othermodifications within the scope and spirit of the claims appended hereto.

What is claimed is:
 1. A surgical instrument comprising: a first memberextending along an axis between opposite proximal and distal endsurfaces, the first member including a channel, a wall and a pluralityof openings, the wall extending from the proximal end surface to thedistal end surface, the openings extending through the distal endsurface and a thickness of the wall; a second member disposed in thechannel, the second member including a passageway configured fordisposal of cut tissue; and a third member including a plurality ofspaced cutting flutes, the third member being disposed in the passagewaysuch that the third member is rotatable relative to the second member totransfer the cut tissue along the axis.
 2. A surgical instrument asrecited in claim 1, wherein the distal end surface extends perpendicularto the axis.
 3. A surgical instrument as recited in claim 1, wherein thewall includes spaced apart sections extending linearly to cuttingsurfaces, the cutting surfaces each extending parallel to the axis alongentire lengths of the cutting surfaces.
 4. A surgical instrument asrecited in claim 1, wherein the second member is fixed relative to thefirst member.
 5. A surgical instrument as recited in claim 3, whereinthe cutting surfaces are disposed about the openings.
 6. A surgicalinstrument as recited in claim 1, wherein the wall includes spaced apartsections extending linearly to cutting surfaces, the spaced apartsections including two sections that are disposed in alignment along anaxis that extends transverse to the axis defined by the first member. 7.A surgical instrument as recited in claim 1, wherein the wall includesspaced apart sections extending linearly to cutting surfaces, the spacedapart sections including two sections that are spaced 180 degrees apart.8. A surgical instrument as recited in claim 1, wherein the plurality ofopenings comprises two spaced openings.
 9. A surgical instrument asrecited in claim 1, wherein the plurality of openings comprises fouropenings.
 10. A surgical instrument as recited in claim 1, wherein thewall includes spaced apart sections extending linearly to cuttingsurfaces, the spaced apart sections including four sections thatcomprise a cruciate cross section configuration.
 11. A surgicalinstrument as recited in claim 1, wherein the wall includes spaced apartsections extending linearly to cutting surface, the spaced apartsections including four sections that are spaced 90 degrees apart.
 12. Asurgical instrument as recited in claim 1, wherein the cutting flutesform helical blades.
 13. A surgical instrument as recited in claim 1,further comprising a fourth member disposed within an interior cavity ofthe third member.
 14. A surgical instrument as recited in claim 1,further comprising a fourth member disposed within an interior cavity ofthe third member such that a transfer channel of the fourth member iscoaxial with the interior cavity.
 15. A surgical instrument as recitedin claim 1, further comprising: a fourth member disposed within aninterior cavity of the third member; and a vacuum source connected withthe fourth member.
 16. A surgical instrument as recited in claim 1,wherein the third member comprises a groove and an irrigation hole thatis in communication with an interior cavity of the third member and thegroove.
 17. A surgical instrument comprising: a housing extending alongan axis between opposite proximal and distal end surfaces, the housingincluding a channel, a wall and a plurality of openings, the wallextending from the proximal end surface to the distal end surface, theopenings extending through the distal end surface and a thickness of thewall; and an auger comprising: a shaft disposed in the channel, theshaft including a passageway configured for disposal of cut tissue, anda cutter including a plurality of spaced cutting flutes, the cutterbeing disposed in the passageway such that the cutter is rotatablerelative to the shaft to transfer the cut tissue along the axis.
 18. Asurgical instrument as recited in claim 17, wherein the openings extendthrough a thickness of the wall, the wall including spaced apartsections extending linearly to cutting surfaces.
 19. A surgicalinstrument as recited in claim 17, wherein the shaft is fixed relativeto the housing.
 20. A surgical instrument comprising: a first memberextending along an axis between opposite proximal and distal endsurfaces, the first member including a channel, a wall and a pluralityof openings, the wall extending from the proximal end surface to thedistal end surface, the openings extending through the distal endsurface and a thickness of the wall, the wall including cuttingsurfaces; a second member disposed in the channel, the second memberincluding a passageway configured for disposal of cut tissue; and athird member including a plurality of spaced cutting flutes, the thirdmember being disposed in the passageway such that the third member isrotatable relative to the second member to transfer the cut tissue alongthe axis, the third member being disposed entirely within thepassageway.